- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $16,178.70 / $26,422.50
| Facility | | $6,303.00 | $16,178.70 | $26,422.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,368.28 / $29,388.72 / $39,433.32
| Facility | | $21,368.28 | $29,388.72 | $39,433.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,507.57 / $24,042.54 / $33,703.69
| Facility | | $17,507.57 | $24,042.54 | $33,703.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,241.92 / $26,701.94 / $33,662.42
| Facility | | $15,241.92 | $26,701.94 | $33,662.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,241.92 / $26,924.22 / $35,305.68
| Facility | | $15,241.92 | $26,924.22 | $35,305.68 |